P M Bradley1, B Lindsay. 1. Thingoe House, Cotton Lane, Bury St Edmonds, UK, IP33 1YJ. peter.bradley@suffolkwest-pct.nhs.uk
Abstract
BACKGROUND: Epilepsy care has been criticised for its lack of impact. Various service models and strategies have been developed in response to perceived inadequacies in care provision. OBJECTIVES: To compare the effectiveness of any specialised or dedicated intervention for the care of adults with epilepsy to the effectiveness of usual care. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE (1966 to May 2006), EMBASE (1988 to May 2006), PsychINFO (1806 to May 2006) and CINAHL (1982 to May 2006). SELECTION CRITERIA: Randomised controlled trials, controlled or matched trials, cohort studies or other prospective studies with a control group, or time series studies. DATA COLLECTION AND ANALYSIS: Each review author independently selected studies, extracted data and assessed the quality of included studies. MAIN RESULTS: There are 13 trials and 16 reports included in this review. Seven distinct groups of interventions were identified: seven papers reported on five trials of specialist epilepsy nurses. Of the 13 trials, at least three (four reports) have methodological weaknesses, and some of the results from other analyses within studies need to be interpreted with caution because of limiting factors in the studies. Consequently, there is currently limited evidence for the effectiveness of interventions to improve the health and life quality of people with epilepsy. It was not possible to combine study results in a meta-analysis because of the heterogeneity of outcomes, study populations, interventions, and time scales across the studies. AUTHORS' CONCLUSIONS: Two intervention types, the specialist epilepsy nurse and self-management education, have some evidence of benefit. However, we did not find clear evidence that other service models substantially improve outcomes for adults with epilepsy. It is also possible that benefits are situation specific and may not generalise to other settings. These studies included only a small number of service providers whose individual competence or expertise may have had a significant impact on outcomes. At present it is not possible to advocate any single model of service provision.
BACKGROUND:Epilepsy care has been criticised for its lack of impact. Various service models and strategies have been developed in response to perceived inadequacies in care provision. OBJECTIVES: To compare the effectiveness of any specialised or dedicated intervention for the care of adults with epilepsy to the effectiveness of usual care. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE (1966 to May 2006), EMBASE (1988 to May 2006), PsychINFO (1806 to May 2006) and CINAHL (1982 to May 2006). SELECTION CRITERIA: Randomised controlled trials, controlled or matched trials, cohort studies or other prospective studies with a control group, or time series studies. DATA COLLECTION AND ANALYSIS: Each review author independently selected studies, extracted data and assessed the quality of included studies. MAIN RESULTS: There are 13 trials and 16 reports included in this review. Seven distinct groups of interventions were identified: seven papers reported on five trials of specialist epilepsy nurses. Of the 13 trials, at least three (four reports) have methodological weaknesses, and some of the results from other analyses within studies need to be interpreted with caution because of limiting factors in the studies. Consequently, there is currently limited evidence for the effectiveness of interventions to improve the health and life quality of people with epilepsy. It was not possible to combine study results in a meta-analysis because of the heterogeneity of outcomes, study populations, interventions, and time scales across the studies. AUTHORS' CONCLUSIONS: Two intervention types, the specialist epilepsy nurse and self-management education, have some evidence of benefit. However, we did not find clear evidence that other service models substantially improve outcomes for adults with epilepsy. It is also possible that benefits are situation specific and may not generalise to other settings. These studies included only a small number of service providers whose individual competence or expertise may have had a significant impact on outcomes. At present it is not possible to advocate any single model of service provision.
Authors: Howard Ring; James Howlett; Mark Pennington; Christopher Smith; Marcus Redley; Caroline Murphy; Roxanne Hook; Adam Platt; Nakita Gilbert; Elizabeth Jones; Joanna Kelly; Angela Pullen; Adrian Mander; Cam Donaldson; Simon Rowe; James Wason; Fiona Irvine Journal: Health Technol Assess Date: 2018-02 Impact factor: 4.014
Authors: Eileen Savage; Paul V Beirne; Muireann Ni Chroinin; Alistair Duff; Tony Fitzgerald; Dawn Farrell Journal: Cochrane Database Syst Rev Date: 2014-09-08
Authors: Nicholas Magill; Leone Ridsdale; Laura H Goldstein; Paul McCrone; Myfanwy Morgan; Adam J Noble; Gus Baker; Mark Richardson; Stephanie Taylor; Sabine Landau Journal: Trials Date: 2015-06-12 Impact factor: 2.279